﻿@using System.Collections;
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    <title>In phiếu: Công dân</title>
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</head>

<body lang=EN-US>
    <div class=WordSection1>
    @{
        <table class=MsoTableGrid border=1 cellspacing=0 cellpadding=0
               style='border-collapse:collapse;border:none; width:100%;'>
            <tr>
                <td width=340 valign=top style='width:254.85pt;border:dotted windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  3.0pt;margin-left:0in;line-height:normal'>
                        <b>
                            <span style='font-family:"Arial","sans-serif"'>
                                HỘ ĐIỀU TRA SỐ: ............
                            </span>
                        </b>
                    </p>
                </td>
                <td width=340 valign=top style='width:254.9pt;border:dotted windowtext 1.0pt;
  border-left:none;padding:0in 5.4pt 0in 5.4pt'>
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  margin-bottom:3.0pt;margin-left:0in;text-align:right;line-height:normal'>
                        <b>
                            <span style='font-family:"Arial","sans-serif"'>
                                CÔNG DÂN SỐ: ..........
                            </span>
                        </b>
                    </p>
                </td>
            </tr>
        </table>

        <p class=MsoNormal><span style='font-size:3.0pt;line-height:107%'>&nbsp;</span></p>

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            <tr style='height:.15in'>
                <td width="5%" valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:.15in'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <b>
                            <span style='font-size:4.0pt;line-height:120%;
  font-family:"Arial","sans-serif"'>&nbsp;</span>
                        </b>
                    </p>
                </td>
                <td width="94%" colspan=4 valign=top style='width:94.36%;border:solid windowtext 1.0pt;
  border-left:none;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:.15in'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <b>
                            <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                                THÔNG TIN CƯ DÂN
                            </span>
                        </b>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" valign=top style='width:5.64%;border-top:none;border-left:
  solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>1.</span>
                    </p>
                </td>
                <td width="23%" rowspan=2 valign=top style='width:23.6%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Họ tên thành viên hộ (Bắt đầu từ chủ hộ)
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            HỌ: <b>..........</b>      TÊN ĐỆM: <b>..........</b>       TÊN: <b>..........</b>
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:19.0pt'>
                <td width="5%" valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt;height:19.0pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>&nbsp;</span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:19.0pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            [Chỉnh
                            sửa]……………………………………………………………….............
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>2.</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Quan hệ với chủ hộ
                        </span>
                    </p>
                    <p class=MsoNormal align=right style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:right;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>[Chỉnh sửa]</span>
                    </p>
                </td>
                <td width="35%" valign=top style='width:35.38%;border:none;border-bottom:
  solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <b>
                            <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                                Chủ hộ
                            </span>
                        </b>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Chủ hộ........................... 1 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Vợ/chồng...................... 2 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Con đẻ........................... 3 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="35%" colspan=2 valign=top style='width:35.38%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Cháu nội/ngoại….. ........... 4 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Bố/mẹ.............................. 5 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Quan hệ khác…. ..............6 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>3.</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Hiện trạng của cư dân
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            Mất tích…. 1 <span style='font-family:"MS Gothic"'>☐</span>        Đã chết…. 2 <span style='font-family:"MS Gothic"'>☐</span>           Đã chuyển đi…. 3 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin:0px 0px 0px 0px;'>
                        <img style="margin-bottom:7px; margin-left:22px;" width=45 height=26 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image005.png")" />
                        <img style="margin-bottom:11px; margin-left:-10px;" width=26 height=22 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image004.png")" />
                        <img style="margin-bottom:4px; margin-left:55px;" width=63 height=29 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image006.png")" />
                        <img style="margin-bottom:0px; margin-left:35px;" width=125 height=33 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image003.png")" />
                        >
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>4.</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Giới tính cư dân
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <i>
                            <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                                <b>..........</b>
                            </span>
                        </i><span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            [Chỉnh
                            sửa]  NAM … 1 <span style='font-family:"MS Gothic"'>☐</span>      NỮ … 2 <span style='font-family:"MS Gothic"'>☐</span>     KXĐ … 3 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" valign=top style='width:5.64%;border-top:none;border-left:
  solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>5.</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày sinh dương lịch
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            NGÀY: <b>..........</b>     THÁNG: <b>..........</b>           NĂM:  <b>..........</b>
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:16.1pt'>
                <td width="5%" valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt;height:16.1pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>&nbsp;</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.1pt'>
                    <p class=MsoNormal align=right style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:right;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>[Chỉnh sửa]</span>
                    </p>
                </td>
                <td width="44%" colspan=2 valign=top style='width:44.44%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.1pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày __ __ Tháng __ __ Năm __ __ __ __
                        </span>
                    </p>
                </td>
                <td width="26%" valign=top style='width:26.32%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.1pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Năm âm: …………………..
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            KXĐ … 3 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" valign=top style='width:5.64%;border-top:none;border-left:
  solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>6.</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            a. Nơi đăng ký khai sinh
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            XÃ: <b>..........</b>     HUYỆN: <b>..........</b>     TỈNH: <b>..........</b>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            [Chỉnh sửa] Xã: …………..Huyện: ………………….Tỉnh: ……………………
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>&nbsp;</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            b. Nơi sinh
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            c. Giấy khai sinh
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>………………………………………………………………………………….......</span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Số:……….Quyển: ………. Ngày__ __Tháng__ __ Năm __ __ __ __
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>7.</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Quê quán
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Xã:……………..Huyện: …………………………..Tỉnh: …………...................
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>8.</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Dân tộc
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <i>
                            <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                                <b>
                                    <span style='font-style:normal'>..........</span>
                                </b>
                            </span>
                        </i><span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            [Chỉnh sửa] Tên dân tộc: …………………………..............
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>9.</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Tôn giáo
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Không
                            tôn giáo … 01 <span style='font-family:"MS Gothic"'>☐</span>           Tên
                            tôn giáo: ………………………………….
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>10.</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Quốc tịch
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <i>
                            <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                                <b>
                                    <span style='font-style:normal'>..........</span>
                                </b>
                            </span>
                        </i><span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            [Chỉnh sửa] Tên quốc tịch: …………………………………..
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" rowspan=2 valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>11.</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Thông tin giấy CMND
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Số CMND: <b>....................</b>
                            Ngày cấp: <b>...../...../.....</b>
                            Nơi cấp: <b>....................</b>
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=right style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:right;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>[Chỉnh sửa]</span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:7.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            CÁC CHỮ VIẾT TẮT
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:8.3pt;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:6.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            CMND – CHỨNG MINH NHÂN DÂN
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Số CMND: __ __ __ __ __ __ __ __ __ __ __ __
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày cấp __ __ Tháng cấp __ __ Năm cấp __ __ __ __
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Nơi cấp: …………………………………………………………………………….
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:47.7pt'>
                <td width="5%" rowspan=3 valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt;height:47.7pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>12.</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:47.7pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            a. Địa chỉ thường trú
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:47.7pt'>
                    <table cellpadding="0" cellspacing="0">
                        <tr>
                            <td>
                                <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                                    Giống địa chỉ hộ … 1 <span style='font-family:"MS Gothic"'>☐</span>
                                </span>
                            </td>
                            <td><img width=64 height=28 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image007.png")" /></td>
                            <td>
                                <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Khác địa chỉ hộ nhà …2<span style='font-family:"MS Gothic"'>☐</span></span>
                            </td>
                            <td><img width=104 height=26 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image008.png")"></td>
                        </tr>
                    </table>

                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>………………………………………………………………………………............</span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Xã:
                            ……………..Huyện: …………………………..Tỉnh: …………...................
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:65.05pt'>
                <td width="23%" valign=top style='width:23.6%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:65.05pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            b.Thông tin sổ hộ khẩu thường trú
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:65.05pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Số sổ hộ khẩu: ……………….Ngày cấp _ _ Tháng cấp _ _ Năm cấp _ _ _ _
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày chuyển đến hộ: Ngày _ _ Tháng _ _ Năm _ _ _ _
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Nơi thường trú trước khi chuyển đến:
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Xã: ……………….Huyện: ………………..…………….Tỉnh: …………............
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:75.65pt'>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:75.65pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            c.
                            Thông tin chủ hộ trong sổ hộ khẩu
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=3 valign=top style='width:70.76%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:75.65pt'>

                    <table cellpadding="0" cellspacing="0">
                        <tr>
                            <td>
                                <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                                    Là chủ hộ dân cư ... 1 <span style='font-family:"MS Gothic"'>☐</span>
                                </span>
                            </td>
                            <td><img width=63 height=28 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image010.png")" /></td>
                            <td>
                                <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Khác chủ hộ dân cư ... 2<span style='font-family:"MS Gothic"'>☐</span></span>
                            </td>
                            <td><img width=103 height=26 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image009.png")"></td>
                        </tr>
                    </table>


                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Tên
                            chủ hộ: ……………………………………………………
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày
                            sinh chủ hộ _ _ Tháng sinh _ _ Năm sinh _ _ _ _
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Dân
                            tộc chủ hộ:    Kinh …. 1<span style='font-family:"MS Gothic"'>☐</span>
                            Dân tộc khác: ……………………………
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:4.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Số
                            CMND chủ hộ: __ __ __ __ __ __ __ __ __ __ __ __
                        </span>
                    </p>
                </td>
            </tr>

        </table>
        <p style="text-align:right;">Trang ..........</p>

        <p style="page-break-after:always;"></p>
        <p style="padding-top:20px;"></p>

        <table class=MsoTableGrid border=1 cellspacing=0 cellpadding=0
               style='border-collapse:collapse;border:none; width:100%; display:none;'>
            <tr>
                <td width=340 valign=top style='width:254.85pt;border:dotted windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  3.0pt;margin-left:0in;line-height:normal'>
                        <b>
                            <span style='font-family:"Arial","sans-serif"'>
                                HỘ ĐIỀU TRA SỐ: ..........
                            </span>
                        </b>
                    </p>
                </td>
                <td width=340 valign=top style='width:254.9pt;border:dotted windowtext 1.0pt;
  border-left:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=right style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:3.0pt;margin-left:0in;text-align:right;line-height:normal'>
                        <b>
                            <span style='font-family:"Arial","sans-serif"'>CÔNG DÂN SỐ: ..........</span>
                        </b>
                    </p>
                </td>
            </tr>
        </table>

        <p class=MsoNormal><span style='font-size:2.0pt;line-height:107%; display:none;'>&nbsp;</span></p>

        <table class=MsoTableGrid border=1 cellspacing=0 cellpadding=0 width="100%"
               style='width:100.0%;border-collapse:collapse;border:none'>
            <tr style='height:.15in'>
                <td width="5%" valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:.15in'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <b>
                            <span style='font-size:4.0pt;line-height:120%;
  font-family:"Arial","sans-serif"'>&nbsp;</span>
                        </b>
                    </p>
                </td>
                <td width="94%" colspan=8 valign=top style='width:94.36%;border:solid windowtext 1.0pt;
  border-left:none;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:.15in'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <b>
                            <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>THÔNG TIN CƯ DÂN</span>
                        </b><span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'></span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>13.</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Nơi
                            ở hiện tại
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                    </p>
                </td>
                <td width="70%" colspan=7 valign=top style='width:70.76%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>

                        <table cellpadding="0" cellspacing="0">
                            <tr>
                                <td>
                                    <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                                        Giống địa chỉ thường trú …1 <span style='font-family:"MS Gothic"'>☐</span>
                                    </span>
                                </td>
                                <td><img width=59 height=28 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image012.png")" /></td>
                                <td>
                                    <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Khác địa chỉ …2<span style='font-family:"MS Gothic"'>☐</span></span>
                                </td>
                                <td><img width=106 height=26 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image011.png")"></td>
                            </tr>
                        </table>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>…………………………………………………………………………………........</span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Xã:
                            ………………..….Huyện: ………………..…….Tỉnh: …………..................
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:49.3pt'>
                <td width="5%" valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt;height:49.3pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>14.</span>
                    </p>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>&nbsp;</span>
                    </p>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>&nbsp;</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:49.3pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Thông
                            tin hộ chiếu
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=7 valign=top style='width:70.76%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:49.3pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Loại
                            hộ chiếu: Phổ thông … 1 <span style='font-family:"MS Gothic"'>☐</span>
                            Công vụ … 2 <span style='font-family:"MS Gothic"'>☐</span>       Ngoại giao …
                            3 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày
                            cấp hộ chiếu: Ngày cấp _ _ Tháng cấp _ _ Năm cấp _ _ _ _
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Nơi
                            cấp hộ chiếu: …………………………………………………………………
                        </span>
                    </p>
                </td>
            </tr>

            <tr style='height:16.35pt'>
                <td width="5%" rowspan=4 valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>15.</span>
                    </p>
                </td>
                <td width="23%" rowspan=4 valign=top style='width:23.6%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Trình
                            độ học vấn
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:7.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            CÁC
                            CHỮ VIẾT TẮT
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:8.3pt;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:6.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            THCS
                            - TRUNG HỌC CƠ SỞ
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:8.3pt;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:6.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            THPT
                            - TRUNG HỌC PHỔ THÔNG
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:8.3pt;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:6.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            CN
                            - CHUYÊN NGHIỆP
                        </span>
                    </p>
                </td>
                <td width="16%" valign=top style='width:16.64%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Mầm non ……..</span>
                    </p>
                </td>
                <td width="6%" valign=top style='width:6.94%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            1 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="18%" colspan=2 valign=top style='width:18.08%;border:none;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>THPT ……………</span>
                    </p>
                </td>
                <td width="6%" valign=top style='width:6.94%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            5 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="13%" valign=top style='width:13.88%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Cao đẳng…</span>
                    </p>
                </td>
                <td width="8%" valign=top style='width:8.28%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            9 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:16.35pt'>
                <td width="16%" valign=top style='width:16.64%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Tiểu học ………</span>
                    </p>
                </td>
                <td width="6%" valign=top style='width:6.94%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            2 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="18%" colspan=2 valign=top style='width:18.08%;border:none;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Trung cấp nghề…</span>
                    </p>
                </td>
                <td width="6%" valign=top style='width:6.94%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            6 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="13%" valign=top style='width:13.88%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Đại học……</span>
                    </p>
                </td>
                <td width="8%" valign=top style='width:8.28%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            10 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:16.35pt'>
                <td width="16%" valign=top style='width:16.64%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>THCS …………</span>
                    </p>
                </td>
                <td width="6%" valign=top style='width:6.94%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            3 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="18%" colspan=2 valign=top style='width:18.08%;border:none;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Trung cấp CN…..</span>
                    </p>
                </td>
                <td width="6%" valign=top style='width:6.94%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            7 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="13%" valign=top style='width:13.88%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Thạc sỹ……</span>
                    </p>
                </td>
                <td width="8%" valign=top style='width:8.28%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            11 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:16.35pt'>
                <td width="16%" valign=top style='width:16.64%;border:none;border-bottom:
  solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Sơ cấp nghề …</span>
                    </p>
                </td>
                <td width="6%" valign=top style='width:6.94%;border:none;border-bottom:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            4 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="18%" colspan=2 valign=top style='width:18.08%;border:none;
  border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Cao đẳng nghề….</span>
                    </p>
                </td>
                <td width="6%" valign=top style='width:6.94%;border:none;border-bottom:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            8 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="13%" valign=top style='width:13.88%;border:none;border-bottom:
  solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Tiến sỹ……</span>
                    </p>
                </td>
                <td width="8%" valign=top style='width:8.28%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            12 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:16.35pt'>
                <td width="5%" rowspan=3 valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>16.</span>
                    </p>
                </td>
                <td width="23%" rowspan=3 valign=top style='width:23.6%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Trình độ chuyên môn kỹ thuật
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:7.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            CÁC CHỮ VIẾT TẮT
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:8.3pt;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:6.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            CN - CHUYÊN NGHIỆP
                        </span>
                    </p>
                </td>
                <td width="16%" valign=top style='width:16.64%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Chưa đào tạo ..</span>
                    </p>
                </td>
                <td width="6%" valign=top style='width:6.94%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            1 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="18%" colspan=2 valign=top style='width:18.08%;border:none;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Trung cấp CN…..</span>
                    </p>
                </td>
                <td width="6%" valign=top style='width:6.94%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            5 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="13%" valign=top style='width:13.88%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Đại học……</span>
                    </p>
                </td>
                <td width="8%" valign=top style='width:8.28%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            9 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:16.35pt'>
                <td width="16%" valign=top style='width:16.64%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Sơ cấp nghề …</span>
                    </p>
                </td>
                <td width="6%" valign=top style='width:6.94%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            2 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="18%" colspan=2 valign=top style='width:18.08%;border:none;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Cao đẳng nghề …</span>
                    </p>
                </td>
                <td width="6%" valign=top style='width:6.94%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            6 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="13%" valign=top style='width:13.88%;border:none;padding:0in 5.4pt 0in 5.4pt;
  height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Thạc sỹ……</span>
                    </p>
                </td>
                <td width="8%" valign=top style='width:8.28%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            10 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:16.35pt'>
                <td width="16%" valign=top style='width:16.64%;border:none;border-bottom:
  solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Trung cấp nghề</span>
                    </p>
                </td>
                <td width="6%" valign=top style='width:6.94%;border:none;border-bottom:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            3 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="18%" colspan=2 valign=top style='width:18.08%;border:none;
  border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Cao đẳng………..</span>
                    </p>
                </td>
                <td width="6%" valign=top style='width:6.94%;border:none;border-bottom:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            7 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="13%" valign=top style='width:13.88%;border:none;border-bottom:
  solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Tiến sỹ……</span>
                    </p>
                </td>
                <td width="8%" valign=top style='width:8.28%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:16.35pt'>
                    <p class=MsoNormal style='margin-top:2.0pt;margin-right:0in;margin-bottom:
  2.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            11 <span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" rowspan=2 valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>17.</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            a.Tình
                            trạng việc làm
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=7 valign=top style='width:70.76%;border-top:none;
  border-left:none;border-bottom:0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>

                        <table cellpadding="0" cellspacing="0">
                            <tr>
                                <td>
                                    <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                                        Chưa đến tuổi đi làm .. 1<span style='font-family:"MS Gothic"'>☐</span>
                                    </span>
                                </td>
                                <td><img width=66 height=28 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image013.png")" /></td>
                                <td>
                                    <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>KXĐ ………………3<span style='font-family:"MS Gothic"'>☐</span></span>
                                </td>
                                <td><img width=63 height=28 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image014.png")"></td>
                            </tr>

                            <tr>
                                <td>
                                    <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                                        Đang thất nghiệp ……. 2<span style='font-family:"MS Gothic"'>☐</span>
                                    </span>
                                </td>
                                <td><img width=63 height=28 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image014.png")" /></td>
                                <td>
                                    <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Đang đi làm ……...4<span style='font-family:"MS Gothic"'>☐</span></span>
                                </td>
                                <td><img width=101 height=26 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image016.png")"></td>
                            </tr>

                            <tr>
                                <td>
                                    <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                                        Hết tuổi đi làm ………. 3<span style='font-family:"MS Gothic"'>☐</span>
                                    </span>
                                </td>
                                <td><img width=62 height=28 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image015.png")" /></td>
                                <td></td>
                                <td></td>
                            </tr>
                        </table>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            b.
                            Thông tin công việc
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=7 valign=top style='width:70.76%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Nghề
                            nghiệp: ………………………………………………………………………….
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Cơ
                            quan, nơi làm việc: ……………………………………………………………….
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>…………………………………………………………………………………………..</span>
                    </p>
                </td>
            </tr>
            <tr style='height:14.35pt'>
                <td width="5%" rowspan=4 valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt;height:14.35pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>18.</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:14.35pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Thông
                            tin về y tế
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=7 valign=top style='width:70.76%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:14.35pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                    </p>
                </td>
            </tr>
            <tr style='height:18.15pt'>
                <td width="23%" valign=top style='width:23.6%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:18.15pt'>
                    <p class=MsoNormal align=right style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:right;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>a. Nhóm máu cư dân</span>
                    </p>
                </td>
                <td width="70%" colspan=7 valign=top style='width:70.76%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:18.15pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Nhóm
                            A …1<span style='font-family:"MS Gothic"'>☐</span>    Nhóm B …2<span style='font-family:"MS Gothic"'>☐</span>          Nhóm AB …3<span style='font-family:"MS Gothic"'>☐</span>      Nhóm O …4<span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:12.75pt'>
                <td width="23%" valign=top style='width:23.6%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:12.75pt'>
                    <p class=MsoNormal align=right style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:right;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>b. Bệnh hiểm nghèo</span>
                    </p>
                </td>
                <td width="70%" colspan=7 valign=top style='width:70.76%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:12.75pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>………………………………………………………………………………..</span>
                    </p>
                </td>
            </tr>
            <tr style='height:22.5pt'>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:22.5pt'>
                    <p class=MsoNormal align=right style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:right;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>c. Tình trạng khuyết tật</span>
                    </p>
                </td>
                <td width="31%" colspan=3 valign=top style='width:31.88%;border:none;
  border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:22.5pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            ..........
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            [Chỉnh
                            sửa]
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Khuyết
                            tật vận động …...1 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Khuyết
                            tật nghe, nói……2 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Khuyết
                            tật nhìn …………3 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="38%" colspan=4 valign=top style='width:38.88%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:22.5pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Khuyết
                            tật thần kinh, tâm thần……4 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Khuyết
                            tật trí tuệ………………...…5 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Khuyết
                            tật khác ……………………6 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:25.35pt'>
                <td width="5%" rowspan=4 valign=top style='width:5.64%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt;height:25.35pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:center;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>19.</span>
                    </p>
                </td>
                <td width="23%" valign=top style='width:23.6%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:25.35pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Thông
                            tin về Bảo hiểm
                        </span>
                    </p>
                </td>
                <td width="70%" colspan=7 valign=top style='width:70.76%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.35pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                    </p>
                </td>
            </tr>
            <tr style='height:25.3pt'>
                <td width="23%" valign=top style='width:23.6%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:25.3pt'>
                    <p class=MsoNormal align=right style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:right;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>a. Bảo hiểm xã hội</span>
                    </p>
                </td>
                <td width="70%" colspan=7 valign=top style='width:70.76%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.3pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Có
                            tham gia ……1 <span style='font-family:"MS Gothic"'>☐</span>      Không tham
                            gia …..2 <span style='font-family:"MS Gothic"'>☐</span>      KXĐ……3 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:25.3pt'>
                <td width="23%" valign=top style='width:23.6%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:25.3pt'>
                    <p class=MsoNormal align=right style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:right;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>b. Bảo hiểm thất nghiệp</span>
                    </p>
                </td>
                <td width="70%" colspan=7 valign=top style='width:70.76%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:25.3pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Có
                            tham gia ……1 <span style='font-family:"MS Gothic"'>☐</span>      Không tham
                            gia …..2 <span style='font-family:"MS Gothic"'>☐</span>      KXĐ……3 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:25.3pt'>
                <td width="23%" valign=top style='width:23.6%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:25.3pt'>
                    <p class=MsoNormal align=right style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:right;
  line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:
  "Arial","sans-serif"'>c. Bảo hiểm y tế</span>
                    </p>
                </td>
                <td width="70%" colspan=7 valign=top style='width:70.76%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:25.3pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  0in;margin-left:0in;margin-bottom:.0001pt;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Có tham gia ……1 <span style='font-family:"MS Gothic"'>☐</span>      Không tham
                            gia …..2 <span style='font-family:"MS Gothic"'>☐</span>      KXĐ……3 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
        </table>
        <p style="text-align:right; padding-top:120px;">Trang ..........</p>

        <p style="page-break-after:always;"></p>
        <p style="padding-top:20px;"></p>

        <table class=MsoTableGrid border=1 cellspacing=0 cellpadding=0
               style='border-collapse:collapse;border:none;width:100%; display:none;'>
            <tr>
                <td width=340 valign=top style='width:254.85pt;border:dotted windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  3.0pt;margin-left:0in;line-height:normal'>
                        <b>
                            <span style='font-family:"Arial","sans-serif"'>
                                HỘ ĐIỀU TRA SỐ: ..........
                            </span>
                        </b>
                    </p>
                </td>
                <td width=340 valign=top style='width:254.9pt;border:dotted windowtext 1.0pt;
  border-left:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=right style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:3.0pt;margin-left:0in;text-align:right;line-height:normal'>
                        <b>
                            <span style='font-family:"Arial","sans-serif"'>CÔNG DÂN SỐ:..........</span>
                        </b>
                    </p>
                </td>
            </tr>
        </table>

        <p class=MsoNormal><span style='font-size:1.0pt;line-height:107%; display:none;'>&nbsp;</span></p>

        <table class=MsoTableGrid border=1 cellspacing=0 cellpadding=0 width="100%"
               style='width:100.0%;border-collapse:collapse;border:none'>
            <tr>
                <td width="5%" valign=top style='width:5.0%;border:solid windowtext 1.0pt;
  background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:3.0pt;margin-left:0in;text-align:center;line-height:120%'>
                        <b>
                            <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                        </b>
                    </p>
                </td>
                <td width="95%" colspan=3 valign=top style='width:95.0%;border:solid windowtext 1.0pt;
  border-left:none;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  3.0pt;margin-left:0in;line-height:normal'>
                        <b>
                            <span style='font-size:10.0pt;
  font-family:"Arial","sans-serif"'>THÔNG TIN QUAN HỆ GIA ĐÌNH</span>
                        </b>
                    </p>
                </td>
            </tr>
            <tr style='height:20.95pt'>
                <td width="5%" rowspan=5 valign=top style='width:5.0%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt;height:20.95pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:3.0pt;margin-left:0in;text-align:center;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>20.</span>
                    </p>
                </td>
                <td width="29%" valign=top style='width:29.72%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:20.95pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Thông tin về cha</span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.95pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Họ tên: <b>..........</b>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            [Chỉnh sửa]: …………………………………………………………………
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:18.95pt'>
                <td width="29%" valign=top style='width:29.72%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:18.95pt'>
                    <p class=MsoNormal align=right style='margin-top:1.0pt;margin-right:0in;
  margin-bottom:1.0pt;margin-left:0in;text-align:right;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày tháng năm sinh cha
                        </span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='width:65.28%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:18.95pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <b>
                            <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                                ..........

                            </span>
                        </b><span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày sinh _ _ Tháng sinh _ _ Năm sinh _ _ _ _
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:12.85pt'>
                <td width="29%" valign=top style='width:29.72%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:12.85pt'>
                    <p class=MsoNormal align=right style='margin-top:1.0pt;margin-right:0in;
  margin-bottom:1.0pt;margin-left:0in;text-align:right;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Dân
                            tộc cha
                        </span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='width:65.28%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:12.85pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Kinh….…….1<span style='font-family:"MS Gothic"'>☐</span>     Dân tộc khác:……………………
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:11.8pt'>
                <td width="29%" valign=top style='width:29.72%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:11.8pt'>
                    <p class=MsoNormal align=right style='margin-top:1.0pt;margin-right:0in;
  margin-bottom:1.0pt;margin-left:0in;text-align:right;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Quốc tịch cha
                        </span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='width:65.28%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Việt Nam …. 1<span style='font-family:"MS Gothic"'>☐</span>     Quốc tịch khác:………………….
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:18.45pt'>
                <td width="29%" valign=top style='width:29.72%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:18.45pt'>
                    <p class=MsoNormal align=right style='margin-top:1.0pt;margin-right:0in;
  margin-bottom:1.0pt;margin-left:0in;text-align:right;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Số
                            CMND cha
                        </span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='width:65.28%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:18.45pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            __
                            __ __ __ __ __ __ __ __ __ __ __
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:20.95pt'>
                <td width="5%" rowspan=5 valign=top style='width:5.0%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt;height:20.95pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:3.0pt;margin-left:0in;text-align:center;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>21.</span>
                    </p>
                </td>
                <td width="29%" valign=top style='width:29.72%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:20.95pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Thông tin về mẹ</span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='width:65.28%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.95pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Họ tên: <b>..............................</b>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            [Chỉnh
                            sửa]: …………………………………………………………………
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:18.95pt'>
                <td width="29%" valign=top style='width:29.72%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:18.95pt'>
                    <p class=MsoNormal align=right style='margin-top:1.0pt;margin-right:0in;
  margin-bottom:1.0pt;margin-left:0in;text-align:right;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày tháng năm sinh mẹ
                        </span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='width:65.28%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:18.95pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <b>
                            <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                                ..........
                            </span>
                        </b><span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày sinh _ _ Tháng sinh _ _ Năm sinh _ _ _ _
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:12.85pt'>
                <td width="29%" valign=top style='width:29.72%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:12.85pt'>
                    <p class=MsoNormal align=right style='margin-top:1.0pt;margin-right:0in;
  margin-bottom:1.0pt;margin-left:0in;text-align:right;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Dân
                            tộc mẹ
                        </span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='width:65.28%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:12.85pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Kinh
                            ….……..1<span style='font-family:"MS Gothic"'>☐</span>     Dân tộc khác:
                            ……………………
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:11.8pt'>
                <td width="29%" valign=top style='width:29.72%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:11.8pt'>
                    <p class=MsoNormal align=right style='margin-top:1.0pt;margin-right:0in;
  margin-bottom:1.0pt;margin-left:0in;text-align:right;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Quốc
                            tịch mẹ
                        </span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='width:65.28%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.8pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Việt
                            Nam …. 1<span style='font-family:"MS Gothic"'>☐</span>     Quốc tịch khác:
                            ………………….
                        </span>
                    </p>
                </td>
            </tr>
            <tr style='height:18.45pt'>
                <td width="29%" valign=top style='width:29.72%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:18.45pt'>
                    <p class=MsoNormal align=right style='margin-top:1.0pt;margin-right:0in;
  margin-bottom:1.0pt;margin-left:0in;text-align:right;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Số
                            CMND mẹ
                        </span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='width:65.28%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt;height:18.45pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            __
                            __ __ __ __ __ __ __ __ __ __ __
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" valign=top style='width:5.0%;border-top:none;border-left:solid windowtext 1.0pt;
  border-bottom:none;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:3.0pt;margin-left:0in;text-align:center;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>21.</span>
                    </p>
                </td>
                <td width="29%" valign=top style='width:29.72%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>a. Người đại diện hợp pháp</span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='width:65.28%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt'>

                    <table cellpadding="0" cellspacing="0">
                        <tr>
                            <td>
                                <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                                    Có ….…….1<span style='font-family:"MS Gothic"'>☐</span>
                                </span>
                            </td>
                            <td><img width=75 height=28 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image018.png")" /></td>
                            <td>
                                <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Không ….…….2<span style='font-family:"MS Gothic"'>☐</span></span>
                            </td>
                            <td><img width=75 height=28 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image017.png")"></td>
                        </tr>
                    </table>

                </td>
            </tr>
            <tr>
                <td width="5%" rowspan=2 valign=top style='width:5.0%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:3.0pt;margin-left:0in;text-align:center;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                    </p>
                </td>
                <td width="29%" valign=top style='width:29.72%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            b.
                            Loại người đại diện hợp pháp
                        </span>
                    </p>
                </td>
                <td width="29%" colspan=1 valign=top style='width:29.84%;border:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Người
                            giám hộ ……….1<span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Cha,
                            mẹ nuôi …………2<span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="35%" colspan=1 valign=top style='width:35.44%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Đại
                            diện cơ sở nuôi dưỡng …..3<span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Khác
                            ………………….………….4<span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="29%" valign=top style='width:29.72%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            c. Thông tin về người đại
                            diện hợp pháp
                        </span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='width:65.28%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Họ
                            và tên: …………………………………………………………………..
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày
                            sinh __ __ Tháng sinh __ __ Năm sinh __ __ __ __
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            Dân tộc:       Kinh ….…….1<span style='font-family:"MS Gothic"'>☐</span>      Dân tộc khác: …………………………..
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            Quốc tịch:    Việt Nam .… 1<span style='font-family:"MS Gothic"'>☐</span>      Quốc tịch khác: ………………………..
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Số
                            CMND: __ __ __ __ __ __ __ __ __ __ __ __
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" rowspan=4 valign=top style='width:5.0%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:3.0pt;margin-left:0in;text-align:center;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>22.</span>
                    </p>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:3.0pt;margin-left:0in;text-align:center;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                    </p>
                </td>
                <td width="29%" valign=top style='width:29.72%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>a. Tình trạng hôn nhân</span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='width:65.28%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Độc
                            thân …1 <span style='font-family:"MS Gothic"'>☐</span>   Đang kết hôn …..2<span style='font-family:"MS Gothic"'>☐</span>     Ly hôn….…3<span style='font-family:"MS Gothic"'>☐</span>      KXĐ…4<span style='font-family:
  "MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  0.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <img width=62 height=26 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image019.png")" style="margin-left:28px;">
                        <img width=84 height=27 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image020.png")" style="margin-left:48px;">
                        <img width=87 height=29 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image021.png")" style="margin-left:20px;">
                        <img width=62 height=26 src="@Url.Content("~/Content/PrintHouseHold/chuan_files/image022.png")" style="margin-left:20px;">
                        >
                    </p>
                </td>
            </tr>
            <tr>
                <td width="29%" valign=top style='width:29.72%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>b. Thông tin vợ/chồng</span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='width:65.28%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Họ
                            và tên vợ/chồng: ……………………………………………………………
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày
                            sinh __ __ Tháng sinh __ __ Năm sinh __ __ __ __
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            Dân tộc:       Kinh ….…….1<span style='font-family:"MS Gothic"'>☐</span>      Dân tộc khác: …………………………..
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>
                            Quốc tịch:    Việt Nam .… 1<span style='font-family:"MS Gothic"'>☐</span>      Quốc tịch khác: ………………………..
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Số
                            CMND: __ __ __ __ __ __ __ __ __ __ __ __
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="29%" valign=top style='width:29.72%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>c. Thông tin giấy kết hôn</span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='width:65.28%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Số/quyển
                            số Giấy chứng nhận đăng ký kết hôn: …………………………
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày
                            đăng ký kết hôn: ngày _ _ tháng_ _ năm_ _ _ _
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Nơi
                            đăng ký kết hôn:  Xã: ………………………………………………………
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Huyện:
                            ………………..………………….Tỉnh: ………….............................
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="29%" valign=top style='width:29.72%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>d. Thông tin giấy ly hôn</span>
                    </p>
                </td>
                <td width="65%" colspan=2 valign=top style='width:65.28%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Số
                            quyết định ly hôn: ………………………………………………………..
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày
                            quyết định ly hôn: ngày _ _ tháng_ _ năm_ _ _ _
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Cấp
                            Toà án công nhận: TW ....01 <span style='font-family:"MS Gothic"'>☐</span>   Tỉnh....02<span style='font-family:"MS Gothic"'>☐</span>   Huyện....03 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Huyện:
                            ………..………………….Tỉnh: …………......................................
                        </span>
                    </p>
                </td>
            </tr>
        </table>

        <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
margin-bottom:3.0pt;margin-left:0in;text-align:center;line-height:normal'>
            <span style='font-size:6.0pt'>&nbsp;</span>
        </p>

        <table class=MsoTableGrid border=1 cellspacing=0 cellpadding=0 width="100%"
               style='width:100.0%;border-collapse:collapse;border:none'>
            <tr>
                <td width="5%" valign=top style='width:5.0%;border:solid windowtext 1.0pt;
  background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;
  margin-bottom:3.0pt;margin-left:0in;text-align:center;line-height:120%'>
                        <b>
                            <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>&nbsp;</span>
                        </b>
                    </p>
                </td>
                <td width="95%" colspan=3 valign=top style='width:95.0%;border:solid windowtext 1.0pt;
  border-left:none;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:
  3.0pt;margin-left:0in;line-height:normal'>
                        <b>
                            <span style='font-size:10.0pt;
  font-family:"Arial","sans-serif"'>THÔNG TIN CHẾT/MẤT TÍCH</span>
                        </b>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" rowspan=2 valign=top style='width:5.0%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:1.0pt;margin-right:0in;
  margin-bottom:1.0pt;margin-left:0in;text-align:center;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>23.</span>
                    </p>
                </td>
                <td width="24%" valign=top style='width:24.14%;border:none;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Ngày chết</span>
                    </p>
                </td>
                <td width="70%" colspan=2 valign=top style='width:70.86%;border:none;
  border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày
                            __ __ Tháng __ __ Năm __ __ __ __
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="24%" valign=top style='width:24.14%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=right style='margin-top:1.0pt;margin-right:0in;
  margin-bottom:1.0pt;margin-left:0in;text-align:right;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Nguyên
                            nhân chết
                        </span>
                    </p>
                </td>
                <td width="35%" valign=top style='width:35.42%;border:none;border-bottom:
  solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Bệnh
                            tật ………………..…...1 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Tai
                            nạn lao động …………..2 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Tai
                            nạn giao thông …….…..3 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
                <td width="35%" valign=top style='width:35.44%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Tai
                            nạn khác ………….…. 1 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Khác
                            ………..………….….4 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            KXĐ
                            ………..………….…. 5 <span style='font-family:"MS Gothic"'>☐</span>
                        </span>
                    </p>
                </td>
            </tr>
            <tr>
                <td width="5%" valign=top style='width:5.0%;border:solid windowtext 1.0pt;
  border-top:none;padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal align=center style='margin-top:1.0pt;margin-right:0in;
  margin-bottom:1.0pt;margin-left:0in;text-align:center;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>24.</span>
                    </p>
                </td>
                <td width="24%" valign=top style='width:24.14%;border-top:none;border-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;line-height:120%'>
                        <span style='font-size:10.0pt;
  line-height:120%;font-family:"Arial","sans-serif"'>Ngày mất tích</span>
                    </p>
                </td>
                <td width="70%" colspan=2 valign=top style='width:70.86%;border-top:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  padding:0in 5.4pt 0in 5.4pt'>
                    <p class=MsoNormal style='margin-top:1.0pt;margin-right:0in;margin-bottom:
  1.0pt;margin-left:0in;text-align:justify;line-height:120%'>
                        <span style='font-size:10.0pt;line-height:120%;font-family:"Arial","sans-serif"'>
                            Ngày __ __ Tháng __ __ Năm __ __ __ __
                        </span>
                    </p>
                </td>
            </tr>
        </table>
        <p style="text-align:right;">Trang ......</p>
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